By Seaman Pyoung K. Yi - Naval Medical Center San Diego Public Affairs
Surgeons at Naval Medical Center San Diego (NMCSD) performed a revolutionary medical procedure known as Ex-utero Intrapartum Treatment (EXIT) Feb. 27.
An EXIT procedure is performed for a fetus at critical risk for airway obstruction at birth. The goal of the procedure is to secure an airway for the fetus to allow routine neonatal resuscitation afterward.
Cmdr. (Dr.) Matthew Brigger, NMCSD’s Pediatric Otolaryngologist and Residency Program Director Otolaryngology Department, Lt. Cmdr. (Dr.) Whitney You, head of maternal fetal medicine, staff nurses and hospital corpsmen successfully performed the EXIT procedure on Alina Bardos, 26, wife of Marine Sgt. Brandon Bardos, assigned to Marine Corps Base Hawaii Kaneohe Bay, and her infant son, Charlie.
“On the surface, the procedure is a C-section where the fetus is partially delivered for airway management,” said Brigger. “In reality, the procedure is a highly-coordinated effort involving the expertise of the pediatric otolaryngology, maternal fetal medicine, pediatric anesthesia and obstetrical anesthesia teams.”
It was the first time an EXIT procedure had been performed in NMCSD’s history, and one of the few times the procedure has been performed at a Department of Defense medical facility.
“The hospital in general, we view ourselves as being a top-tier academic institution,” said Brigger. “Procedures like this are what is done at high-level places that provide the highest level of care. From our standpoint, this is something we expect to be able to do.”
The EXIT procedure required an unprecedented number of medical personnel, and a handful of teams, to carry out the surgery.
“We’ve never had to work with four or five teams at a time,” said You. “We learned the power of a team, how to communicate as a team, and how amazing we can be if we put our minds together and accomplish a task.”
According to Brigger, an EXIT procedure is rarely performed. This type of surgery is uncommon and few medical establishments have the requisite specialists and coordination abilities to accomplish such a complex procedure.
Months before the surgery, the Bardos’ infant, Charlie, was found through imaging to have severe micrognathia, or an extremely small jaw. This condition meant Charlie was at critical risk for airway obstruction at birth.
“The degree of micrognathia presented a significant airway management challenge,” said Brigger. “In my opinion, without proper planning, this child would’ve been placed at an unacceptable mortality risk at birth.”
Prior to the procedure, the medical team met with Brandon and Alina, informed them in detail about the surgery and advised them on what to expect.
“We were able to have plenty of time to sit with the family and work through the issues,” said Brigger. “We discussed our findings, how we expected things to happen and what would be the different alternatives.”
Alina and Brandon, who already have two children, were a bit distressed upon initially hearing the news about their unborn son’s condition and the surgery he would have to endure.
“Everybody expects a healthy baby and to have a healthy child,” said Brandon. “It took me about two weeks to come to terms with it. It was pretty surreal.”
“We had a lot of family support that made it easier to deal with,” added Alina.
Although the EXIT procedure was a success, Charlie, who was born at 35 weeks gestation, still has some long-term medical conditions to overcome. But the future is looking considerably brighter for the Bardos family, whose infant son’s success thus far is owed to the dedication of the various medical personnel who have cared for him at NMCSD.
“This is a premier hospital,” said Brigger. “By being able to do a procedure such as this, it allows us to continue to deliver state of the art care in everything that we do.”
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